Research published in April 2018 in Child Care in Practice explored in depth the help-seeking behaviours of those affected by substance-use disorder among family members, with a view to informing the design and delivery of support services for affected persons.1 The study focused on affected family members’ use and assessment of available supports, barriers encountered in accessing supports, and recommendations for overcoming these barriers.

Background

There is an increasing awareness that persons affected by the substance-use behaviours of their family members are in need of support in their own right. Support can enable affected family members to learn ways of coping with the emotional, psychological, and physical stress experienced as a result of problem substance use in their family. Formal support for affected family members is provided through community, voluntary, and statutory addiction services and through specialised family support and family-based programmes. Affected family members may also access support informally through family, friends, and community, and semi-formally through professionals in other sectors.

Research links the adequacy of the support received with positive outcomes for families.2,3 However, research suggests that affected family members tend to put their family’s wellbeing before their own and to seek help for their family member and not themselves.4,5 Additionally, affected family members may avoid seeking help because of the stigma attached to persons who have issues with problem substance use and to their associates.6

Method

Interviews were conducted with 10 participants (nine females and one male) who were recruited through Drug and Alcohol Task Forces and statutory drug services across urban and rural locations. Participants were persons with at least one family member with a history of substance-use disorder for a minimum of five years and who had sought support from at least one formal drug/alcohol service/programme. Participants had varying relationships to their family members (parents, partner, sibling, and adult child) and the circumstances of their family members ranged from active substance use, to in recovery, to deceased.

Findings

Participants reported multiple negative consequences of the substance use of their family member, including overdose, attempted suicide, bereavement, imprisonment, and drug-related intimidation and violence. Participants experienced stress and strain and feelings such as guilt, shame, fear, embarrassment, and a sense of failure. Typically, participants had endured the problem behaviour of their family member for years, only seeking help when the situation became chaotic or unmanageable. Prior to seeking help for their family member, participants had not considered that they might benefit from support in their own right. Participants also lacked awareness of available supports and of the kinds of support that might best suit their needs.

Participants learned about available supports through family members, colleagues and social services, or were referred from peer-led support to counselling and other support services. All participants had at some point accessed either a drug education programme, family support, a residential treatment centre or (most commonly) addiction counselling. Other supports included Al-Anon, parent education initiatives, general counselling, yoga, church, and mindfulness. Informal supports, where accessed, were created through contact with formal supports. Semi-formal supports were more common and included general practitioners, Gardaí, teachers, and work colleagues. Most participants accessed more than one type of support for reasons including availability, preference, location, and logistics. All had sought informal or semi-formal support before coming into contact with formal supports.

For participants, perceived stigma, shame, embarrassment and concerns around confidentiality and anonymity were significant barriers to accessing support and to engaging with support once accessed. Additional barriers were an absence of local supports, long distance travel, childcare, and poor awareness of relevant issues among related professionals. A lack of interagency cooperation was further cited as a barrier.

Participants were positive about the formal support they received, but felt that both semi-formal and informal supports (including family) sometimes lacked relevant knowledge, empathy, and understanding. The benefits of accessing support included emotional support, better coping, enhanced wellbeing, and feeling less isolated and more informed. Participants also described increased self-esteem and confidence from family support and counselling. To overcome barriers to accessing support, participants suggested education and awareness programmes in schools and public spaces, as well as increasing the visibility of supports through various media. Participants further suggested better integration of formal supports and the upskilling of professionals providing semi-formal support.

Implications

The authors suggest that full implementation of the existing National Drugs Rehabilitation Framework and Protocols7,8 for coordination and integrated working among drug and alcohol family support services would address many of the barriers identified by participants. They propose that better coordination of local services is needed to ensure affected family members can easily access support appropriate to their needs. They further propose that service provision would be enhanced though additional investment, wider availability of family support, and increased capacity within the sector to work with affected family members. The authors highlight the role of policymakers and national organisations in service development, promotion, education, awareness, and training of the workforce.

Conclusion

Persons affected by problem substance use in their family experience considerable stress and strain and are often isolated and unaware of supports available to them. The study has highlighted the support needs of this group, as well as the barriers they encounter in accessing support, including the stigma that surrounds problem substance use. It has also provided suggestions for enhancing the provision of supports for affected families and for challenging stigma. Findings of the study must be interpreted in light of the study limitations, however, which include the small sample size and the gender imbalance among participants.

2  Gardner R (2006) Safeguarding children through supporting families. In P Dolan, J Canavan and J Pinkerton (eds), Family support as reflective practice (pp. 103–117). London: Jessica Kingsley.

3  Sheppard M (2009) Social support use as a parental coping strategy: its impact on outcome of child and parenting problems – a six-month follow-up. Br J Soc Work, 39(8): 1427–46.

4  Barnard M (2007) Drug addiction and families. London: Jessica Kingsley.

5  Salter G and Clark D (2004) The impact of substance misuse on the family: a grounded theory analysis of the experiences of parents. Swansea: WIRED and Department of Psychology, University of Wales.

6  Keyes KM, Hatzenbuehler ML, McLaughlin KA, Link B, Olfson M, Grant BF, et al. (2010). Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol, 172(12): 1364–72.

7  National Drugs Rehabilitation Implementation Committee (2010) National Drugs Rehabilitation Framework document. Dublin: Health Service Executive. https://www.drugsandalcohol.ie/13502/

8  National Drugs Rehabilitation Implementation Committee (2011) National protocols and common assessment guidelines to accompany the National Drugs Rehabilitation Framework. Dublin: Health Service Executive. https://www.drugsandalcohol.ie/16717/